Provider Demographics
NPI:1588826622
Name:RIVERBEND SERVICES INC.
Entity Type:Organization
Organization Name:RIVERBEND SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:910-618-9260
Mailing Address - Street 1:6688 NC HIGHWAY 41 NORTH
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-1768
Mailing Address - Country:US
Mailing Address - Phone:910-618-9260
Mailing Address - Fax:352-293-3128
Practice Address - Street 1:6688 NC HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2501
Practice Address - Country:US
Practice Address - Phone:910-618-9260
Practice Address - Fax:352-293-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0707UOtherBLUE CROSS BLUE SHIELD
NC137810OtherMEDCOST
NC5950227Medicaid